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Three Secrets to Take Control of an
Unruly Order Set Catalog
Session 136, February 13, 2019
Paula Scariati, DO, MPH, MS
Medical Director Health Informatics, Dignity Health
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Paula Scariati, DO, MPH, MS has no real or
apparent conflicts of interest to report.
Conflict of Interest
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• The Problem
• Order sets Versus Protocols
• The Three As
• Lessons Learned
• Next Steps
Agenda
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Why Am I Here?
What Do I Stand
For?
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• List the key data that should be tracked as part of
Evidence-based Knowledge Governance (EKG)
• Define the process for assigning a clinical home to an
electronic order set
• Identify strategies that make Evidence-based
Knowledge Governance (EKG) physician friendly
Learning Objectives
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Why Am I Here?
What Do I Stand
For?
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Dignity Health
• 5
th
largest nonprofit health
system in the U.S.
• 22-state network of 9,000
physicians
• More than 400 care centers
• 62,000 employees
• Provides more than $2.2
billion in community benefit
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The Problem
• Lack of visibility into order sets that need
updating
• Undefined oversight
• Lack of centralized governance
• Understaffed order set teams
• Lack of build standards
• Single source of truth
• Versioning control
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The Scope
• First EHR go live 10+ years ago
• Acute + Ambulatory
• Over 1200 order sets
• 2 domains
• 8 regions
• Discontinued using order set management
software in 2013
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Why Am I Here?
What Do I Stand
For?
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Order Set
Menu Order
Set
Enterprise
Group
Enterprise
Evidence
Review
Protocol
Order Set
Local
P&T
P&T
Evidence
Review
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Order Set
Menu Order
Set
Enterprise
Group
Enterprise
Evidence
Review
Protocol
Orderset
Local
P&T
P&T
Evidence
Review
• Evidence-based order set that offers
a menu of choices to physician
• If new evidence is published, order
set knowledge is updated via
specialty-specific decision body
• No CMS regulations on how often
these should be reviewed
• On-demand & if age > 3 years
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Order Set
Menu Order
Set
Enterprise
Decision
Body
Enterprise
Evidence
Review
Protocol
Order Set
Local
P&T
P&T
Evidence
Review
On-Demand
or
Age > 3 yrs
Annual
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Three Secrets
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Automate the
Data
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Assign Order Sets
a Home
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Assure a Physician
Friendly Process
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People
Process
Platform
Physicians
Nursing
Clinical Informaticist
Pharmacy Informaticist
Quality
System PT
Physician Informaticist
EHR Builders
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EKG Review
Is a Team Sport
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Process
Before Meeting
• Decision body core team reviews their EKG report during the
prep meeting
• EKG placed as discussion item on decision body agenda –
led by facilitator or chair
During Meeting
• Decision body members determine order set to review
• One regional physician and regional clinical informaticist
(volunteered /voluntold) to perform a first-level (initial) review
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Guidelines for Annotating
Please place order sentences under the correct
heading and maintain the standard heading
order observed for all Dignity Health
PowerPlans:
• ADT/Consents
• Vital Signs
• Activity
• Patient Care
• Respiratory
• Diet
• IV Solutions
• Medications
• Laboratory
• Diagnostic Tests (Radiology)
• Consults
Please place order sentences under the correct
heading and maintain the standard heading
order observed for all Dignity Health
PowerPlans:
• ADT/Consents
• Vital Signs
• Activity
• Patient Care
• Respiratory
• Diet
• IV Solutions
• Medications
• Laboratory
• Diagnostic Tests (Radiology)
• Consults
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• Lead with the data – assigning an order set a home can be tricky
• Have guidelines for defining best practice
– NCCN for Oncology regimens
• Make nursing and pharmacy an integral part of the review process
– Communication orders
– Protocols
– Formulary standardization
– Antimicrobial Stewardship
• Don’t let the perfect be the enemy of the good
• Work with build team to track date last reviewed
• Set expectations on TAT and throughput
Lessons Learned
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• C-suite sponsor
• Core team socialization
• Assign each order set a home
• Create tracking mechanism
• Pilot with one or two specialty groups to refine the process for
your organization
Next Steps
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• Glenda Colahan – Project Manager
• Cassandra Baqir – IT Technical Analyst
• Stuart Gray – Clinical Applications Analyst
• Missie Altree – Enterprise Clinical Informaticist
• Yvette Kirk – Pharmacy Optimization
• Steve Hori – Pharmacy Optimization
The EKG Team
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